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Tobacco Free Task Force Report To President Curtis

April 8, 2019 President Curtis created the ISU Tobacco Free Task Force (TFTF) in September 2018. The President appointed Dr. Andy Morgan, Dean of Students, and Dr. Doug Urban, Assistant Professor of Applied Medicine & Research as Chairpersons and 19 other members were appointed. A complete list of the TFTF members is provided in Attachment 1. This report is a summary of the TFTF’s efforts. The TFTF met four times during the fall 2018 semester and created seven subcommittees. Each of these subcommittees researched pros and cons that relate to their subcommittee and the impact of going Tobacco Free, Smoke Free, or not changing anything with the current policy. It was quickly learned that the TFTF’s membership was like a bell curve, meaning

1. some members were very passionate about not changing anything with the policy because they are a smoker or knew of others that would be impacted by any changes,

2. others were very passionate about expanding the policy and becoming Tobacco Free, and

3. most felt they and their constituents would not be impacted either way with any policy changes.

The sub-committees shared numerous research articles regarding tobacco and smoking policies, the dangers of tobacco, electronic smoking devices, vaping, and second hand smoke. Many of these articles are cited in this report. According to the American Nonsmokers’ Rights Foundation (2019), as of January 2, 2019, 2,342 campuses are 100% smoke-free; of these 1,975 are also 100% tobacco-free. Indiana institutions with comprehensive tobacco-free policies are: Indiana University satellite campuses, Indiana Wesleyan University, Rose Hulman Institute of Technology, Saint Mary of the Woods College, Purdue University satellite campuses, University of Evansville, University of Indianapolis, and more. No campus can be found that expanded their tobacco free policies and then rolled them back. The TFTF also heard from Dr. Olabode Ayodele, ISU Assistant Professor of Applied Health Sciences, who presented research on tobacco policies. Dr. Olabode Ayodele’s spring 2016 study was based on a validated survey, “Tobacco-Free College Assessment Survey for Staff, Faculty and Students”. It was created and distributed to ISU students, faculty, and staff by Dr. Olabode Ayodele from the Department of Applied Health Sciences. ISU participants included 1,668 students, 303 staff, and 186 faculty members. No incentives were given to complete the survey. Results from survey were: 66% supported a tobacco-free policy, 60% were concerned about exposure to secondhand smoke, 81% felt that cigarette litter detracts from campus’ appearance, 48% were dissatisfied with current compliance, and 82% felt that universities have a responsibility to adopt a tobacco-free policy. The study concluded that ISU students, staff, and faculty demonstrated positive attitudes toward tobacco-free campus policy change.

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Additionally, the adoption and implementation of the policy should incorporate strategies to raise awareness of the importance of tobacco-free campus policies in reducing health hazards associated with second hand smoke. Committee member, Katie Lugar, presented information in regards to the American Cancer Society $12,000 grant that will assist with policy change, cessation, and signage. Additionally, Lugar shared extensive research and data on the variety of campus policies. A Smoke-Free Policy means no smoking is allowed in the area. A Tobacco-Free Policy means no form of tobacco use is allowed in the area. This includes cigarettes, pipes, cigars, smokeless tobacco, and nicotine delivery systems not approved by the Federal Food and Drug Administration to assist with tobacco cessation. This also includes products designed to mimic tobacco products. A Comprehensive Tobacco-Free Policy means prohibition of use of tobacco products on all campus property at all times including in vehicles and there are no designated areas for smoking. Research by Lugar also found that when a campus implements a comprehensive tobacco-free policy that there is:

1. Reduction in tobacco use on campus and intention to use tobacco products on campus (Fallin, Roditis, & Glantz, 2015; Lechner et al., 2012)

2. Additional protection against exposure to secondhand smoke (Braverman et al., 2018; Bennett, Deiner, & Pokhrel, 2017; Lechner et al., 2012; Okoli et al., 2016)

3. Reduction in the social acceptability of smoking (Lechner et al., 2012; Lochbihler, Miller,& Etcheverry, 2014; Seo et al., 2011)

4. Additional prevention in youth and young adult initiation of tobacco use – 99% of adult cigarette smokers first start smoking before age 26 (American Cancer Society, 2018; Majeed et al., 2015; Wilson et al., 2012)

5. Reduction in cigarette litter (Bennett, Deiner, & Pokhrel, 2017; Fallin, Roditis, & Glantz, 2015; Lee et al., 2013)

6. Positive impact on grounds & facilities management workloads (Glassman, Reindl, & Whewell, 2011)

7. Clear expectations for compliance & simplifies enforcement (Fallin et al., 2012; Fallin-Bennett et al., 2017)

8. Helps individuals who are trying to quit using tobacco (Borders et al., 2005; Lechner et al., 2012).

9. No significant impacts on student enrollment or applications (Miller et al., 2015) 10. Additional preparation for students for tobacco-free workplaces (American Lung

Association, 2019) 11. Promotes overall sustainability (Lerner et al., 2015; Marah & Novonty, 2011; Novotny et

al., 2011) 12. Increased enrollment in tobacco cessation programs (Bennett, Deiner, & Pokhrel, 2017;

Hahn et al., ) 13. Increased productivity of faculty and staff (Berman et al., 2014; Glassman, Reindl, &

Whewell, 2011) 14. Tobacco-free policies are attractive aspects for new employees (Miller et al., 2015)

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In a fall 2018 survey, Student Government Association surveyed students and 80% identified as not using tobacco products. The survey found that 55% support a “complete ban on tobacco products on the campus of ISU”. The remaining 45% were split between undecided and no. A review of the current ISU policy (https://www.indstate.edu/policy-library/campus-tobacco-policy) found that the policy does not mention vaping or e-cigarettes and allows for smoking “in designated smoking areas on campus”. Current policy prevents vaping in buildings, but more education is needed. Since vaping is newer, there is a false perception that it is less harmful than tobacco smoke. Tobacco setting off fire alarms accounts for two fire alarms in three years. Fire alarms caused by vaping has increased from 13 in 2016, to 31 in 2017, but down to 16 in 2018. Marijuana accounts for two fire alarms in 2016, seven in 2017, and 9 in 2018. The TFTF also discussed tobacco use and its impact on employee productivity. Research conducted by Berman et al. (2014) regarding lost productivity due to absenteeism, presenteeism, and smoke breaks compared costs between workers who smoked and workers who did not smoke. Assuming that only two cigarettes are smoked outside of sanctioned break times each day, and that it takes 15 minutes to smoke each cigarette, the annual per-smoker cost of lost productivity due to unsanctioned smoking breaks was $3,077.24. Task force members provided feedback on several drafts of this proposal. This proposal evolved from the previous draft, Draft 4. Members voted and provided comments on the Draft 4. Twenty of the 21 members voted, of those, seven voted no and 13 voted yes, meaning 65% were in favor of the TFTF proposal. The TFTF member vote is consistent with Dr. Olabode Ayodele’s spring 2016 study in which 66% of the respondents supported a tobacco-free policy. Almost all TFTF members provided comments with their vote. From the Draft 4 comments, minor additions and/or edits were made to this proposal. Many no votes contradicted each other, therefore in the recommendations there are some contradicting recommendations. The TFTF had several subcommittees. Below are the summaries of each subcommittee and suggested recommendations:

1. Employee Benefits/Health Insurance a. HR wellness exams are completed annually on employees and their spouse if

they are on the ISU insurance. This exam tests for tobacco usage in the last 72 hours.

b. Employees of Indiana State University and their spouses covered by the University’s health coverage, who are users of tobacco products currently, have a tobacco surcharge of $50 per month each. A tobacco user is anyone who uses any form of tobacco product, e.g., cigarettes, cigars, pipes, plus tobacco products applied to the gums e.g., dip, chew, or snuff.

c. An individual may temporarily avoid the surcharge if they are actively involved in a Tobacco Cessation Program. There is a two-year limit to the waiver of the surcharge while involved in a Tobacco Cessation Program.

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d. ISU HR and insurance does not do a follow up wellness exam with employee and spouse until the following year’s wellness exam. Data on the number of ISU employees who tested positive as a smoker & choose to do cessation:

i. 2014: 70 ii. 2015: 122

iii. 2016: 72 iv. 2017: 56 v. 2018: 37

1. However, 145 employees & 94 spouses are paying the surcharge rather than opting for the cessation program.

e. Recommendations: i. Expand the health insurance tobacco surcharge to include electronic

smoking devices, so vaping is included. ii. ISU may choose to do random tobacco/vaping usage testing for those

enrolled in cessation. iii. Expand tobacco/vaping usage testing for dependents between the

ages of 18-26 who are on the employee’s (parent) health insurance. iv. Employment Application: ask if the applicant is willing to comply with

ISU’s smoke and tobacco free policy. Union Health currently asks this on their application.

2. Electronic Smoking Devices / Vaping a. There is a current lack of education on the dangers of electronic smoking

devices/vaping nationally and locally. The Federal Drug Administration started researching e-cigarettes in September 2018.

b. Young adults do not think of vaping as smoking, so they believe they can vape anywhere outside on campus. Users can put THC oils into vaping.

c. Recommendations: i. Include electronic smoking devices/vaping in all language associated

with tobacco and smoke free. ii. Expand educational programming and materials in regards to

electronic smoking devices/vaping. 3. Smoke Shelters

a. The current smoke shelters (Attachment 2) do provide a specific location for smokers to smoke on the ISU campus.

b. Many are visible in high traffic areas, which may promote the smoking habit (Kelly, Vuolo, & Frizzell, 2018). The visibility of these shelters may provide a poor image to potential students and parents.

c. Brighter Image and ISU Grounds staff currently clean these shelters six days per week. The Brighter Image invoice for contracted cleanup for the past year was $8,839.92. ISU Grounds staff time adds another $3,000 a year in labor for smoke shelter to cleanup. Shelter issues include occasional reports of criminal mischief such as broken glass, homeless and others using them to sleep in, and occasionally as restrooms.

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d. Tobacco Free Blue, the Office of Sustainability, Facilities Management, and the Center for Community of Engagement facilitated cigarette butt cleanups.

i. Fall 2017: During a 2-hour service activity with 13 volunteers in fall 2017, 4,683 cigarette butts were collected across campus including surrounding smoke shelters, outside academic and residential buildings, and in campus parking lots.

ii. Spring 2018: During a 1.5-hour service activity with three volunteers in spring 2018, 2,462 cigarette butts were collected at two locations on campus with 1,607 collected by the Holmstedt Hall smoke shelter and 855 collected by Cunningham Memorial Library.

iii. Spring 2019: During a one-hour service activity with four volunteers in March 2019, 1,886 cigarette butts were collected around Root Hall, the Holmstedt Hall smoke shelters, the Cunningham Memorial Library, and Parking Lot M.

e. Recommendations: of the 7 TFTF members who voted no on the Draft 4 proposal, three indicated they do not want these smoke shelters to be removed, however two indicated they voted no because they believe the smoke shelters should be removed. Therefore, there are four options in regards to these shelters.

i. Option 1: Remove all smoke shelters. Removing all Smoke Shelters will save nearly $12,000 in labor charges. Considering there are planned budget cuts for FY20, this savings can help.

1. However, if smoke shelters are removed, it may move smoking to our neighbors and then they are responsible for cleaning up the area.

2. Therefore, it is recommended that the Center for Community Engagement, Tobacco Free Blue, and the Office of Sustainability in partnership with Facilities Management organize service opportunities to clean up the areas that border the ISU campus.

ii. Option 2: Do not remove any smoke shelters. iii. Option 3: Move smoke shelters to less visible areas. Move the 5th

Street shelter to 4th Street and move the shelter between the Fine Arts Building and Holmstedt hall closer to the Root Hall Parking Lot. All other shelters will be removed.

1. However, Public Safety has major concerns about moving the shelters. They state that the shelter on 5th Street was moved from the 4th Street location because of violence (robberies). Public Safety believes it will be unsafe to move it back to 4th Street.

2. Facilities estimate $2,000 - $4,000 to place the new concrete pad, disassemble and relocate each shelter; therefore it will cost nearly $8,000 to relocate these two shelters.

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iv. Option 4: Same as Option 3 above, but after one year, all Smoke Shelters will be removed so the campus may progress to a fully tobacco-free campus by year two.

v. Littering Policy: there is no ISU policy in regards to littering on the ISU campus. Cigarette butts are a form of litter. Considering the amount of cigarette butts found on our campus and the potential removal of smoke shelters could increase the amount of litter. A policy focusing on maintaining the beauty of our campus and preventing littering on our campus should be implemented. Furthermore, signage on promoting “keep ISU beautiful” in regards to this litter policy and that ISU is smoke, vapor, and tobacco free can be passive ways of enforcing these policies.

4. Cessation & Enforcement a. Student Health Center, Student Health Promotion, Student Counseling

Center, and Human Resources provide treatment options on how to stop tobacco and vaping usage.

b. Other than in the residence halls, most campus enforcement policies are self-policing. Some institutions have student or staff groups that they train to confront or intervene and a few offer printed cards to hand out (Fallin et al., 2013; Hahn et al., 2012; Ickes et al., 2013; Ickes et al., 2015). Based on review of Indiana colleges and universities, most institutions do not have public safety or police involved in the enforcement of the policy.

c. Research shows that approximately 70% of people who use tobacco want to quit (Centers for Disease Control and Prevention, 2017). Tobacco-free policies in combination with cessation support can help people follow through with quitting.

d. Cessation programs cost money, but the savings in health insurance may help with that cost. Freshstart is an American Cancer Society tobacco cessation program, which is currently facilitated through Employee Wellness at no cost to participants. The Indiana QuitLine is a phone/online-based cessation service, which also has no costs for referrals or use by participants.

e. Enforcement: feedback from SIU Carbondale stated that when their campus started a tobacco-free policy that only allowed smoking in private vehicles, their campus police assisted in enforcing this policy. Their students were referred to their Student Rights & Responsibilities office for student conduct violations. Their employees were referred to Human Resources and the employee’s supervisor was notified. For the first month, their police provided warnings, but the most effective enforcement was from the campus’ faculty, staff, and students who put peer pressure on violators and the amount of smoking that occurred on campus did decrease. This is still true today.

i. ISU Public Safety is concerned that their officers will be spending time responding to and taking reports of policy violations instead of criminal matters.

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f. Recommendation regarding Enforcement: i. The use of legal electronic smoking devices, hookah, smoking, and/or

tobacco products is only permitted in the enclosed cabin of privately owned vehicles. Therefore, smoking is not allowed outside the vehicle, such as sitting on the tailgate of a pickup truck or on a motorcycle, scooter, or bicycle.

ii. Policy violations may be reported to the ISU Police Department. ISU Police will forward alleged policy violations made by employees to the Office of Human Resources for potential disciplinary action as it relates to Policy 562.1 and students to the Dean of Students for potential disciplinary action as it relates to the Code of Student Conduct.

1. Staff: staff employees who violate the policy may have these violations documented in their employee evaluation for failure to abide by ISU Policies. Any violations will need to be reported to Human Resources who then notifies the employee’s supervisor. The supervisor and/or Human Resources shall provide education about the policy and connect the employee to cessation resources, which will be documented in the employee’s file.

2. Students: students who violate the policy will be referred to Student Conduct and Integrity. If the student is found in violation, the student will be educated on the policy and connected to cessation services.

iii. Peer Group: students and employees will be trained to educate violators they see around campus by providing policy and cessation information cards.

g. Recommendation regarding Cessation: i. Apply for grants to assist with smoking cessation.

ii. Provide time away from work for cessation classes and provide cessation classes during work times.

1. Some TFTF members disagreed with staff having paid time away from work for cessation classes. Human Resources should consider allowing staff to take sick leave to attend these classes.

iii. Provide Quit Kits to individuals interested in tobacco cessation. iv. Expand educational programs and materials to educate students and

employees on the dangers of vaping, tobacco, and smoke. v. Peer ambassadors can assist with enforcement by providing policy

education and connection to cessation resources to persons who violate the policy.

5. Marketing, Communication & Education

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a. Any change in signage will cost money, but the American Cancer Society grant will assist with this funding. Much of the awareness and education of the policy can be done via social media. Information about the policy can also be included in a designated ISU website.

b. Recommendation: i. New building signage estimate from ISU Facilities Management: The

lettering will be $38.10 per side with Facilities Management installing them. The campus has about 150 signs (lettering both sides). Materials will cost around $11,500 and about $2,000 for installation. Total estimate is $13,500. Examples are below:

6. Outreach/Neighbors

a. Neighboring residences and businesses are those north of Cherry Street between 9th and 3rd Street, east of 7th Street and west side of 3rd Street, between Cherry and Tippecanoe. Specifically the following areas would be impacted:

i. The Deming ii. Insomnia Cookies

iii. Launch Terre Haute iv. Thiemann Office Products, Inc. v. United Campus Ministries and neighboring churches

vi. Circle K/Shell vii. Hardee’s

viii. The Annex ix. Clabber Girl x. Ballyhoo

b. University Owned “Off the main Campus” buildings maybe difficult to enforce a changed policy. These areas include:

i. 500 Wabash ii. University Apartments

iii. Early Childhood Education Center

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iv. Memorial Stadium v. Sycamore Outdoor Center

vi. Bob Warn Field c. Tobacco Free Blue, Student Health Promotion, Employee Wellness, the Office

of Sustainability, and Facilities Management coordinated a Quit Kit assembly in which 150 bags were created to assist with cessation.

d. Recommendations: the Center for Community Engagement, Tobacco Free Blue, and the Office of Sustainability in partnership with Facilities Management should organize service opportunities to clean up the areas that border the ISU campus.

Based on the findings above, the TFTF recommends the following changes to Policy 955: 955 Campus Tobacco Smoke and Tobacco, Vapor, and Smoke Free Campus 955.1 Overview of Policy Because Indiana State University is committed to providing a safe and healthy working and learning environment for the students, faculty, and staff on its campus, it hereby adopts the following tobacco-free policy. Indiana State University has a commitment to the health and wellness of its students, faculty, and staff. This commitment is demonstrated by the Student Health Promotion and Student Recreation Center programs coordinated by the Division of Student Affairs, by the efforts of the Employee Assistance Program coordinated through the Office of Human Resources, and by curricula and activities in several academic units throughout the University.

955.1.1 Indiana Law Sets Minimum Standards. Health Risks of Use of Smoke and Tobacco Products. Documented research has substantiated the health problems caused by electronic smoking devices, hookah, smoking, tobacco products both smoking and passive smoke. The General Assembly of the State of Indiana adopted the Indiana Clean Indoor Air Law, which is applicable to all state entities in order to address concern for the health and wellness of all Indiana government employees and students. This law sets forth minimum standards but allows state agencies to adopt more stringent rules if desired. Both the City of Terre Haute (General Ordinance No. 19) and Vigo County (Chapter 58) have passed ordinances that prohibit or limit smoking in public places and places of employment. 955.1.2 Applicability. Indiana State University has established the following policy regarding smoking for all facilities and vehicles in which University functions or services are carried out or offered.Definitions:

A. “Electronic Smoking Device” means any product containing or delivering nicotine or any other substance intended for human consumption that can be used by a person in any manner for the purpose of inhaling vapor or aerosol from the product. The term includes any such device, whether

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manufactured, distributed, marketed, or sold as an e-cigarette, e-cigar, e-pipe, e-hookah, or vape pen, or under any other product name or descriptor.

B. “Hookah” means a water pipe and any associated products and devices which are used to produce fumes, smoke, and/or vapor from the burning of material including, but not limited to, tobacco, shisha, or other plant matter.

C. “Smoking” means inhaling, exhaling, burning, or carrying any lighted or heated cigar, cigarette, pipe, hookah, or any other lighted or heated tobacco or plant product intended for inhalation, including marijuana, whether natural or synthetic, in any manner or in any form. “Smoking” also includes the use of an electronic smoking device, which creates an aerosol or vapor, in any manner or in any form, or the use of any oral smoking device for the purpose of circumventing the prohibition of smoking in this Policy.

D. “Tobacco Product” means any substance containing tobacco leaf, including but not limited to, cigarettes, cigars, pipe tobacco, hookah tobacco, snuff, chewing tobacco, dipping tobacco, bidis, blunts, clove cigarettes, or any other preparation of tobacco; and any product or formulation of matter containing biologically active amounts of nicotine that is manufactured, sold, offered for sale, or otherwise distributed with the expectation that the product or matter will be introduced into the human body by inhalation; but does not include any cessation product specifically approved by the U.S. Food and Drug Administration for use in treating nicotine or tobacco dependence.

955.2 Prohibition of Sales. The sale of electronic smoking devices, hookah, smoking, and tobacco products tobacco products is prohibited on university-owned, operated, or leased property. 955.3 Prohibition of Smoking Electronic Smoking Devices, Hookah, Smoking, and Tobacco Product Use. The use of electronic smoking devices, hookah, smoking, and tobacco productssmoking tobacco products is prohibited on university-owned, operated, or leased property, including vehicles.

955.3.1 Exception for Private Vehicles and Designated Areas.. The use of legal electronic smoking devices, hookah, smoking, and/or tobacco smoking tobacco products is permitted in the enclosed cabin of privately owned vehicles and in designated smoking areas on campus.

955.3.2 Other Exceptions. Any exceptions for the use of electronic smoking devices, hookah, smoking, and/or tobaccosmoking tobacco products on university-owned, operated, or leased property will be limited to specific university-sponsored research in a controlled laboratory settingmust be approved by the President or Provost.

955.4 Enforcement

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Enforcement of this policy will depend on the cooperation of all faculty, staff, and students not only to comply with the Policy, but also to encourage others to comply, in order to promote a healthy environment in which to work, study, and live. Peer ambassadors can assist with enforcement by providing policy education and connection to cessation resources to persons who violate the policy. 955.5 Violations Policy violations may be reported to the ISU Police Department. ISU Police will forward alleged policy violations made by employees to the Office of Human Resources for potential disciplinary action as it relates to Policy 562.1 and students to the Dean of Students for potential disciplinary action as it relates to the Code of Student Conduct. Observation of a violation of the policy should be reported to Public Safety at 5555. Follow up for violations of the policy should be referred to the appropriate administrative office for review and action for faculty through the office of Academic Affairs, for staff through Human Resources and to the Dean of Students for students.

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Attachment 1: Tobacco Free Task Force Members

First Name Last Name Role Department

Andy Morgan Co-Chair Dean of Students

Doug Urban Co-Chair Asst. Professor of Applied Medicine & Research

Lauren Baines Member Student Health Promotion

Michele Barrett Member Public Safety

Maha Fahli Member SGA Representative

Sarah Froderman Member Staff Council Representative

Melissa Grinslade Member Student Counseling Center

Eric Hampton Member Faculty Senate Representative

Allison Hayes Member Student Conduct & Integrity

Karen James Member Staff Council Representative

Jim Jensen Member Facilities Management

Sarah Kearns Member UAP, Student Health Center

Stephen Lamb Member SGA Representative

Katie Lugar Member Tobacco Free Blue/Honors College

Nick McCreary Member Office of Sustainability

Lisa Moore Member University Marketing

Erica Myers Member Human Resources

Ardell Sanders Member Residential Life

Tonya Sawyer Member Athletics

Donna Selman Member Faculty Senate Representative

Art Smith Member Sodexo

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Attachment 2: Smoke Shelter locations 2018

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American Lung Association. (2019). Tobacco-free campuses. Retrieved from https://www.lung. org/local-content/illinois/our-initiatives/tobacco-free-campus.html

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